October 7, 2019

The Honorable Kevin McAleenan Robert R. Redfield, M.D. Acting Secretary Director U.S. Department of Homeland Security Centers for Disease Control and Prevention 3801 Nebraska Avenue, NW 1600 Clifton Road Washington, DC 20528 Atlanta, GA 30329-4207

The Honorable Alex Azar Jerome M. Adams, M.D. Secretary Surgeon General of the United States U.S. Department of Health and Human Office of the Surgeon General Services U.S. Department of Health and Human 200 Independence Avenue, SW Services Washington, DC 20201 200 Independence Avenue, SW Washington, DC 20201

Dear Acting Secretary McAleenan, Secretary Azar, Director Redfield, and Surgeon General Adams:

As organizations representing medical professionals, the public health community and individuals who are immunocompromised, we are writing to urge the U.S. Department of Homeland Security (DHS) to reconsider its decision to not vaccinate families in the custody of U.S. Customs and Border Protection (CBP) against influenza (flu). The deaths of three children in CBP custody from influenzai have been deeply troubling and immunizing these families against influenza and other vaccine-preventable diseases would help prevent additional tragedies.

We know Secretary Azar, Director Redfield, and Surgeon General Jerome Adams strongly believe in the value and cost savings of timely immunizations for people of all ages. The Centers for Disease Control and Prevention (CDC) estimates that vaccinations given to children born in the United States between 1994-2018 will prevent approximately 419 million illnesses, 26.8 million hospitalizations, and 936,000 deaths, and will save nearly $1.9 trillion in total societal costs.ii

Unfortunately, every season flu causes millions of illnesses, hundreds of thousands of hospitalizations and thousands or tens of thousands of deaths in the U.S. Children, pregnant women, the elderly and those with certain chronic conditions such as asthma, diabetes and heart disease are at particular risk of flu and its serious complications.iii During the 2018-19 season, there were between 531,000 and 647,000 hospitalizations and between 36,400 and 61,200 deaths, including the death of 136 children, as a result of influenza.iv According to a 2017 study, flu vaccinations not only lower people’s risk of serious illness and hospitalizations, they can also reduce a child’s risk of dying from the virus by half.v

Influenza and many other vaccine-preventable diseases are highly contagious. Vaccinating people in custody will not only protect those individuals, but also the people who work in the CBP facilities, along with their families and their communities. According to the CDC, when people with flu cough, sneeze or talk, they can spread flu to others up to six feet away. Most healthy adults may be able to infect others beginning one day before symptoms develop and up to 5 to 7 days after becoming sick. Children and some people with weakened immune systems may pass the flu virus to others for more than 7 days. Additionally, symptoms of flu, such as fever, muscle aches, and fatigue, usually come on suddenly, and children often have subtler signs of illness than adults.vi

With the official start of the new flu season rapidly approaching and cases of the disease already being reported throughout the country, the CDC is recommending everyone over the age of six months get vaccinated by the end of October if possible.vii In order for vaccines to effectively stop the spread of disease in the U.S., however, we must ensure all people within our borders are fully vaccinated according to the Advisory Committee on Immunization Practices’ recommendations.

For all these reasons and many more, the presence of pediatricians, primary care physicians, pediatric nurses and other health professionals who regularly treat children is vital to ensuring proper immunizations and care. Therefore, we strongly urge you to allow pediatric health professionals, as well as general healthcare professionals, greater access to children and adults detained in CBP facilities.

Experts have raised serious concerns about the risks of detention, particularly on children.viii We urge you not to compound these risks by failing to immunize those in detention from potentially fatal diseases, such as flu.

Sincerely,

Alliance for Immunizations in Michigan (AIM) American College of Physicians (ACP) American Pharmacists Association (APhA) American Public Health Association (APHA) The Arizona Partnership for Immunization (TAPI) Arkansas Immunization Action Coalition (ImmunizeAR)

Association of Immunization Managers (AIM) Association of Schools and Programs of Public Health California Immunization Coalition Central Oklahoma Immunization Coalition Central Pennsylvania Immunization Coalition Colorado Children's Immunization Coalition (CCIC) Colorado Parents for Vaccinated Communities The Emily Stillman Foundation EverThrive IL Families Fighting Flu Gerontological Society of America (GSA) Greater Salt Lake Immunization Coalition Hawaii Immunization Coalition Ohio Chapter, American Academy of Pediatrics Idaho Immunization Coalition Immunization Action Coalition (IAC) Immunization Coalition of Delaware Immunization Collaboration of Tarrant County (TX) Immunize Kansas Coalition Immunize Nevada ImmunizeTN Indiana Immunization Coalition Infectious Diseases Society of America (IDSA) Kimberly Coffey Foundation March of Dimes Meningitis B Action Project National Association of County and City Health Officials (NACCHO) National Association of Pediatric Nurse Practitioners (NAPNAP) National Foundation for Infectious Diseases (NFID) New Jersey Immunization Network Nurses Who Vaccinate Oklahoma Alliance for Healthy Families Parents of Kids with Infectious Diseases (PKIDs) Pediatric Nurse Practitioner House Calls Pennsylvania Immunization Coalition (PAIC) PITCH – Partner Immunizing Toward Community Health (Florida) San Francisco Immunization Coalition Sioux Falls Area Immunization Coalition The Immunization Partnership Trust for America’s Health (TFAH) UNITY Consortium Vaccinate California Vaccinate Massachusetts Vaccinate Your Family (VYF)

Vaccine Ambassadors Vaccine Education Center at Children’s Hospital of Philadelphia Voices for Vaccines West Virginia Immunization Network, a program of the Center for Rural Health Development, Inc

i https://www.cnbc.com/2019/08/20/the-us-wont-vaccinate-migrant-children-against-the-flu-at-border- camps.html ii https://www.cdc.gov/vaccines/programs/vfc/protecting-children.html iii https://www.cdc.gov/flu/about/keyfacts.htm iv https://www.cdc.gov/flu/weekly/index.htm v https://pediatrics.aappublications.org/content/141/4/e20172918 vi https://www.cdc.gov/flu/about/disease/spread.htm vii https://www.cdc.gov/flu/prevent/vaccinations.htm viii https://www.sciencedirect.com/science/article/abs/pii/S0277953619302138?via%3Dihub